title: Reactivation of herpes simplex virus type 2 after initiation of antiretroviral therapy.
abstract: BACKGROUND
  The association between initiation of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection and possible herpes simplex virus type 2 (HSV-2) shedding and genital ulcer disease (GUD) has not been evaluated.
  
  
  METHODS
  GUD and vaginal HSV-2 shedding were evaluated among women coinfected with HIV and HSV-2 (n = 440 for GUD and n = 96 for HSV-2 shedding) who began ART while enrolled in a placebo-controlled trial of HSV-2 suppression with acyclovir in Rakai, Uganda. Monthly vaginal swabs were tested for HSV-2 shedding, using a real-time quantitative polymerase chain reaction assay. Prevalence risk ratios (PRRs) of GUD were estimated using log binomial regression. Random effects logistic regression was used to estimate odds ratios (ORs) of HSV-2 shedding.
  
  
  RESULTS
  Compared with pre-ART values, GUD prevalence increased significantly within the first 3 months after ART initiation (adjusted PRR, 1.94; 95% confidence interval [CI], 1.04-3.62) and returned to baseline after 6 months of ART (adjusted PRR, 0.80; 95% CI, .35-1.80). Detection of HSV-2 shedding was highest in the first 3 months after ART initiation (adjusted OR, 2.58; 95% CI, 1.48-4.49). HSV-2 shedding was significantly less common among women receiving acyclovir (adjusted OR, 0.13; 95% CI, .04-.41).
  
  
  CONCLUSIONS
  The prevalence of HSV-2 shedding and GUD increased significantly after ART initiation, possibly because of immune reconstitution inflammatory syndrome. Acyclovir significantly reduced both GUD and HSV-2 shedding and should be considered to mitigate these effects following ART initiation.
authors.affiliation: Department of Pathology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA. atobian1@jhmi.edu
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.forename: Mary K
authors.initials: MK
authors.lastname: Grabowski
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Kevin
authors.initials: K
authors.lastname: Newell
authors.forename: Paschal
authors.initials: P
authors.lastname: Ssebbowa
authors.forename: Veronica
authors.initials: V
authors.lastname: Franco
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D060085:Coinfection / Q000188:drug therapy / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006558:Herpes Genitalis / Q000150:complications* / Q000821:virology*; D018258:Herpesvirus 2, Human / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos / Q000008:administration & dosage; D014454:Uganda; D014621:Vagina / Q000821:virology; D014775:Virus Activation; D017201:Virus Shedding; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D010919:Placebos; D000212:Acyclovir
keywords: Uganda; acyclovir; herpes simplex virus type 2 (HSV-2); human immunodeficiency virus (HIV); immune reconstitution inflammatory syndrome (IRIS); reactivation